Healthcare Provider Details

I. General information

NPI: 1821653205
Provider Name (Legal Business Name): MOSES CONE PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N CHURCH ST STE 100
GREENSBORO NC
27401-1447
US

IV. Provider business mailing address

PO BOX 745040
ATLANTA GA
30374-5040
US

V. Phone/Fax

Practice location:
  • Phone: 336-890-2210
  • Fax: 336-890-2211
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLY HAMMOND
Title or Position: EXECUTIVE DIRECTOR, OPERATIONS
Credential:
Phone: 336-663-5007